Breakfast consumption, saturated fat intake, and body mass index among medical and non-medical students: a cross-sectional analysis

Changes in dietary patterns and body weight have become a focus of research in undergraduate students. This study compared breakfast consumption, intake of foods high in saturated fat, and BMI between medical and non-medical students. A comparative cross-sectional study was conducted in 4,561 Peruvian university students, of whom 1,464 (32.1%) were from the medical field and 3,097 (67.9%) from the non-medical field. We compared the frequency of breakfast consumption (categorized as regular: 6 to 7 days/week; occasional: 3 to 5 days/week; and rarely or never: 0 to 2 days/week) and the frequency of consumption of foods high in saturated fat. We created simple and multiple linear and Poisson regression models with robust variance to evaluate the association of the mentioned variables with academic fields. Non-medical students (Adjusted Prevalence Ratio [PR] = 0.92, 95% CI 0.86–0.99; p = 0.008) were less likely to eat breakfast regularly compared to medical students. Likewise, consumption of foods high in saturated fats was higher in non-medical students (B = 1.47, 95% CI 0.91–2.04; p < 0.001) compared to medical students. Similarly, the mean BMI of these students was significantly higher than that of medical students (B = 0.33, 95% CI 0.12–0.53; p = 0.002). Although medical students reported relatively healthy eating habits and a lower BMI, there is a widespread need to promote improved diet and lifestyle among the entire university population to reduce the risks of communicable diseases and improve quality of life.


Breakfast consumption
To determine the frequency with which the participants ate breakfast, the following standard question was applied: How often do you eat breakfast per week?This question has been used in previous research [27][28][29] .Participants were asked to indicate, through a numerical response of 0 to 7, the number of days per week that they usually had breakfast.Based on their responses, the frequency of breakfast consumption was classified into three different levels: those who had breakfast "rarely or never" did so between 0 and 2 days a week; the "occasional" group included those who had breakfast between 3 and 5 days a week; and "regular" was considered those who had breakfast between 6 and 7 days a week 28,29 .

Consumption of foods high in saturated fats
To assess the habitual intake of foods rich in saturated fats among the participants, a previously designed and validated food frequency questionnaire was used 30 .This instrument was adapted and validated for the Peruvian university population and consists of 16 items 1 .The assessment of the consumption of these foods was carried out using scales that assign points based on frequency: "never or 1 time per month or less" is assigned 0 point; "2 to 3 times per month" equals 1 point; "1 to 2 times a week" is considered with 2 points; "3 to 4 times a week" is awarded 3 points; and consumption "5 or more times a week" receives 4 points.Therefore, a lower score indicates a very low fat intake, while a higher score reflects a high fat intake.The reliability of the questionnaire was confirmed with coefficient values greater than 0.90, including an ordinal alpha of 0.94, an omega of 0.94 and an H of 0.95, demonstrating its high reliability and suitability to measure saturated fat intake in this population group 1 .BMI Data on the weight and height of the students were collected through self-reporting within the study's framework.The BMI was calculated for each participant using the provided information.BMI categorization was performed according to the World Health Organization (WHO) guidelines, which establish different weight categories.The category 'underweight' is identified with a BMI less than 18.5; "Normal weight" is defined as having a BMI ranging from 18.5 to 24.9 kg/m 2 ; the range classified as ' overweight' is between 25.0 and 29.9 kg/m 2 , while ' obesity' is defined as having a BMI of 30 kg/m 2 or higher 31 .

Sociodemographic information
Sociodemographic information was collected using a set of six questions that covered various essential categories for the study.These categories included aspects such as age, sex, marital status, and religion.In addition, the field of study was considered: students of health sciences (Nursing, Nutrition and Dietetics, and Medicine) and students of non-health fields (Theology, International Commerce, Business Administration, Engineering and Architecture, and Human Sciences and Education, among others).

Statistical analysis
The first activity of the statistical analysis consisted of evaluating the validity and reliability of the instruments used to ensure the rigor with which the variable is measured in the study sample.Subsequently, a descriptive analysis was performed to describe categorical and numerical variables using absolute and relative frequencies and mean with standard deviation, respectively.Furthermore, we compared general characteristics, breakfast consumption, and intake of foods rich in saturated fats according to the study fields.To determine the existence of statistically significant differences between groups in our independent variables, we applied the Student's t-test to numerical variables and the chi-square test of independence to categorical variables.Finally, we create linear regression models and Poisson regression model (Prevalence Ratios) with robust variance to investigate the association between regular breakfast consumption, intake of foods high in saturated and BMI with academic fields, adjusting for age, sex, and parental education.A threshold of statistical significance was established with a value of p < 0.05 for all tests performed.Data analysis was performed using R statistical software, version 4.3.2 32.

Ethics approval and consent to participate
Informed consent was obtained electronically, ensuring that student participation was completely voluntary and based on a clear understanding of their involvement in the study.Ethical approval of the research protocol was granted by the Research Ethics Committee of the Universidad Peruana Unión, under approval number 2022-CEUPeU-0010.The conduct of the study was rigorously aligned with international ethical standards, following the principles dictated in the Declaration of Helsinki and its subsequent amendments.

Results
The average age of the participants was 21.4 years.Females represented 74.7% of students in medical fields.Significantly more medical students were single (95.1%) and professed the Adventist religion (58.7%).Regular breakfast consumption is associated with the medical field (p = 0.024).Non-medical students were more likely to report the consumption of foods high in saturated fat (p < 0.001).Additionally, these students had a higher mean score (18.25) in the consumption of foods rich in saturated fats than medical students (16.39; p < 0.001).
Non-medical students (Adjusted PR = 0.92, 95% CI: 0.86 -0.99; p = 0.008) were significantly less likely to have breakfast regularly compared to those in the medical field.Similarly, in relation to fat intake, non-medical students (B = 1.47, 95% CI: 0.91 -2.04; p < 0.001) are more likely to have a high consumption of foods rich in saturated fats compared to those of medical specialties.Similarly, medical students have a significantly lower mean BMI than non-medical students (B = -0.33,95% CI: -0.53--0.12;p = 0.002) (Table 3).

Discussion
This comparative cross-sectional analysis not only sheds light on the dietary preferences of future health professionals and those in other academic disciplines, but also invites reflection on the implications of such choices.Although breakfast habits can reveal trends toward a more or less healthy lifestyle, the intake of foods rich in saturated fats and BMI provide a picture of risks and behaviors associated with non-communicable diseases, which are of particular interest in the field of public health 33 .The results of the study indicate that: (a) compared to medical students, those studying other disciplines have a lower tendency to consume breakfast regularly; (b) it is observed that students from disciplines other than health sciences tend to have a higher frequency of consumption of foods with high levels of saturated fats; and (c) similarly, it was found that the average BMI is significantly higher in students who do not study medical sciences compared to their peers in the medical field.

Regularity of breakfast consumption
Regular breakfast consumption contributes significantly to daily intake of essential nutrients, such as vitamins and minerals, including calcium, iron, and B vitamins 34 .Scientific evidence and current recommendations for daily breakfast intake from national and international organizations, such as the Peruvian Ministry of Health and the Academy of Nutrition and Dietetics, agree that breakfast is an effective way to start the day, providing the energy and nutrients essential for optimal performance in both children and adults 35,36 .Additionally, they highlight the importance of including a variety of foods in breakfast, such as whole grains, fruits, lean proteins, and low-fat or non-fat dairy products 35,36 .Moreover, regular breakfast consumption has been associated with improved cognitive performance, due to enhanced attention, concentration, and memory, especially among school and university populations 5,6 .However, despite the benefits associated with regular breakfast consumption, the tendency to skip this meal is common among the university population.
In the current study, it was found that non-medical students exhibit a lower tendency to eat breakfast regularly.These findings are consistent with the results of a study in which 18,231 students in Mongolia were evaluated, revealing that medical students reported higher breakfast consumption than non-medical students 12 .Following that same line of thought, recently, a cross-sectional survey of 839 university students in Pakistan found that a higher proportion of non-medical students reported skipping breakfast (30.23% vs. 26.96%)compared to their health sciences counterparts 37 .It is worth mentioning that these differences can be framed in the perception of the importance of nutrition and wellness among students in health sciences and other academic fields.It is possible that medical students, due to their training in health sciences, may be more aware of the importance of maintaining healthy eating habits, including regular consumption of breakfast 13,37 .For example, in a study in which participants were asked if breakfast was an essential component of their daily diet, 57.4% of medical students responded affirmatively; however, 65% of non-medical students did not, demonstrating a significant difference between the two groups 13 .
On the other hand, we found that more than 44% of the students reported skipping breakfast.These findings are consistent with previous studies.For example, research among Chilean university students aged 18 to 27 years of age in various fields revealed that 47% of them did not regularly eat breakfast 3 .Similarly, a study conducted among medical and biomedical science students found that 49.8% skipped breakfast 9 .www.nature.com/scientificreports/Furthermore, another study evaluating a group of medical students at a Peruvian university highlighted that breakfast was the least consumed meal, skipped by 54.4% of the participants 11 .Additionally, a study conducted in medical students indicated that the overall rate of breakfast omission reached 71.92% 10 .
While medical students may be more inclined to regularly consume breakfast due to their increased awareness of health, these findings nonetheless highlight a concerning trend toward skipping breakfast among the university student population at large, suggesting a potential area of intervention to improve eating habits.In fact, there is a clear need to expand nutritional education and promote healthy eating habits among students from all disciplines.The implementation of strategies and programs focused on the importance of breakfast could contribute significantly to the academic performance of the student population in general 5,6 .Furthermore, the

Consumption of foods high in saturated fats
Consumption of foods rich in saturated fats, trans fats and cholesterol has been associated with an increased probability of developing cardiovascular disease, because it increases serum cholesterol levels in the blood 38 .In response to the risks associated with the intake of these foods, international organizations, such as the American Heart Association, advise that adults keep their consumption of saturated fats below 7% of total daily calories, trans fats below 1% of total daily calories and cholesterol to less than 300 mg per day 39,40 .Similarly, the 2010 Dietary Guidelines for Americans recommend limiting the intake of sources of saturated and trans fats, including products such as butter, beef fat, poultry fat, pork fat (lard), solid margarine and vegetable shortening 41 .In Peru, in June 2019, the Ministry of Health published the Manual of Advertising Warnings as part of Law No. 30021, the Law for the Promotion of Healthy Eating, which requires front-of-package labeling on processed food products that are high in saturated fats and contain trans fats 42 .These recommendations aim to promote a healthy lifestyle and decrease the consumption of foods high in saturated fats by encouraging dietary habits that reduce the risk of cardiovascular diseases.
The current findings reveal that non-medical students tend to have a higher frequency of consumption of foods rich in saturated fats.In our study we evaluated the frequency of consumption of foods rich in saturated fats such as fried chicken, hot dogs, french fries, pizza, hamburger, red meat, among others.The findings of our study are in line with a study that reported that the consumption of red meat and fast foods, such as French fries, pizza, and hamburgers, was consumed more frequently in nonmedical students, as was other ultraprocessed products, such as cookies, cakes, chocolates, chips, or sticks 19 , which are rich in saturated fats and contain trans fats 43 .Similarly, in a recent study that explored food consumption patterns among university students, when asked about their purchasing habits at fast food restaurants, it was found that a significantly higher proportion of non-medical students reported buying this type of food, with 61.19% compared to 57.51% of medical students 37 .These results could be explained considering that medical students tend to have a deeper and more detailed knowledge about healthy lifestyle habits compared to students in other disciplines 20 .
However, it is important to note that previous findings showed that students in both medical and non-medical fields showed elevated rates of fast-food consumption, which are a source of saturated and trans fats 19,37 .In our study, the overall scores for the consumption of foods high in saturated fats were 17.45, which equates to a moderately high level of consumption.On the other hand, interestingly, the results of one study reported that fast food consumption was more frequent among medical students than non-medical students 13 .This indicates that, despite the differences observed, the tendency to opt for fast food is significantly high among the university population in general.This pattern suggests the existence of common factors, such as convenience, lack of time to prepare healthy foods, or lack of knowledge about healthy eating, that could influence students' food choices, regardless of their field of study.
It is important to highlight that while knowledge about healthy eating habits is essential, it does not automatically lead to their adoption 44,45 .To promote healthy eating among university students, it is essential to address the underlying barriers, as well as to encourage a healthier food environment and to promote strategies that facilitate more nutritious and balanced food choices.In any case, the high proportion of students who resort to foods high in saturated fats highlights the urgent need to address these issues through health and nutrition education, as well as to promote healthy food alternatives in the university environment..This risk, spread over time, can significantly impact not only students' quality of life but also their academic performance and future careers 47,48 .Our research consistently shows that students enrolled in non-medical schools have a significantly higher average BMI compared to those in medical fields.This observation is in line with the existing literature, which indicates a significant prevalence of overweight among the student population, especially among those enrolled in non-medical fields 19,22 .Previous research has shown that around 20% of university students are overweight, with a higher prevalence of excess weight observed among students in non-medical fields 19 .Furthermore, a study found that the proportion of students with a BMI ≥ 25 was lower in medical schools (28.7%) compared to students from other disciplines (37.9%) 22 .Despite these trends, some studies have found no statistically significant differences in average BMI values between students in medical specialties and those in other academic areas 25,49,50 .In fact, interestingly, in certain investigations, the average BMI of medical science students was slightly higher 25,49,50 .These differences can be attributed to various contextual and methodological factors, such as variations in lifestyles, access to health and nutrition information, and the population sample studied.The results' variability emphasizes the complexity of the factors influencing BMI and the necessity for comprehensive approaches to better comprehend these patterns in diverse college populations.

Limitations and future research
The interpretation of the results obtained in this study is subject to several limitations that must be considered.First, the research was conducted within a specific university context, involving students from a single institution.This implies that the findings do not necessarily reflect the dietary trends and behaviors of the general population of university students, thus limiting their applicability and generalizability to broader contexts.Given this scenario, future research is essential to broaden the scope of study, including more diverse and representative samples of students from various universities and geographical contexts.
Second, in the current study, weight and height were self-reported, which may introduce bias or error, such as the flat slope-syndrome, where heavier individuals tend to underestimate their weight and shorter individuals tend to overestimate their height.However, to minimize risks in our study, we implemented several strategies.These included emphasizing to participants the importance of providing accurate information, assuring them of confidentiality, and explaining how their data would contribute significantly to the research.Additionally, we offer comprehensive and standardized guidelines for measuring weight and height.This approach aimed to enhance accountability and accuracy in the responses provided.
Third, both breakfast consumption and the frequency of consumption of foods high in saturated fat were based on self-reported reports by participants.This approach is susceptible to response biases, as participants may have difficulty accurately recalling their eating habits or may tend to present a more favorable picture of their eating behavior.Therefore, it is important that future research employ more objective and accurate methods to collect data on dietary patterns, such as the use of validated food diary or tracking of the diet through mobile applications.

Implications for public health
Although the present study has certain limitations, we believe that the results obtained are of considerable importance, particularly in terms of public health and the development of health-based education and prevention policies.The study findings highlight several public health concerns that deserve attention.On the one hand, the fact that non-medical students show less regularity in breakfast consumption suggests an opportunity for educational interventions aimed at improving the eating habits of this population.The importance of breakfast in the maintenance of a healthy metabolism and in the prevention of noncommunicable diseases is well documented, which makes it essential to encourage its regular consumption among all university students, regardless of their field of study.
On the other hand, the tendency of non-medical students to consume foods with high levels of saturated fats highlights the need for nutrition education programs that promote greater awareness of the consequences of a diet rich in this type of fat.These programs could focus on teaching about the risks associated with excessive consumption of saturated fats, including cardiovascular disease and obesity, and offer practical strategies to adopt a more balanced diet.
Finally, the finding that the average BMI is significantly higher among non-medical students highlights a critical concern regarding obesity and overweight, conditions that are risk factors for numerous noncommunicable diseases.This suggests the importance of designing and implementing student wellness programs that include physical activity and weight management education components, especially for those in non-medical disciplines.These programs could help students maintain a healthy BMI and understand the importance of an active lifestyle and proper nutrition, contributing to the prevention of lifestyle-related diseases.

Conclusion
This cross-sectional study compared breakfast consumption and intake of foods high in saturated fats between medical and non-medical students.It was found that non-medical students exhibited a lower tendency to regularly consume breakfast compared to medical students.In addition, it is observed that non-medical students tend to have a higher frequency of consumption of foods high in saturated fats.Similarly, non-medical students had a significantly higher average BMI compared to their peers in the medical field.Despite the relatively healthy

Figure 1 .
Figure 1.Composition of the sample.

Table 1 .
Sociodemographic characteristics, breakfast consumption, intake of foods high in saturated fats, and BMI according to academic fields.M: Mean, SD: Standard Deviation; BMI: Body mass index.a Student's t-test and chi-square test of independence.

Table 2 .
28equency of consumption of foods rich in saturated fats in medical and non-medical students.achisquaretest of independence.needtoaddress breakfast skipping is highlighted, as it is associated with several negative health effects, including an increased risk of obesity and metabolic diseases28.

Table 3 .
Simple and multiple regression models of regular breakfast consumption and intake of foods high in saturated fat.Linear regression was used for the intake of foods high in saturated fat score, and Poisson regression with robust variance was used for the regular breakfast consumption variable.PR: Prevalence Ratios; B: Regression coefficient; BMI: body mass index.aAdjustedfor age, sex, and parental education.BMIHigh BMI in undergraduate students, whether medical or non-medical, presents various challenges and considerations for overall health and well-being.The scientific literature has established a clear relationship between a high BMI and an increased risk of developing non-communicable diseases, such as type 2 diabetes, cardiovascular disease, and certain types of cancer